Health at every size – comfortable eating and comfortable lies

In recent weeks I have become aware of the beginings of a popular movement asserting that obesity is not a healthcare problem.  This article will be the first in a likely irregular series looking at some aspects of this movement.

Last week the Guardian ran an opinion piece by a dietician by the name of Lucy Aphramor.  Ms Aphramor was promoting the Health At Every Size (HAES) philosophy;

HAES promotes tested and achievable ways to optimise health for individuals and populations. It does this at an individual level by focusing on eating, activity and body acceptance. Of course, food and exercise are old targets in the health promoter’s arsenal, and psychological factors influencing dieting behaviours are well-known. So what’s new? The crucial difference is that HAES emphasises the benefits of sound nutrition, active living and body confidence as ends in themselves, not as a route to weight management.

There does not seem to be anything controversial about this statement, bit wishy washy maybe, bit idealistic, ’sound nutrition’ may be a shibboleth of the alternative health world but its use here may be coincidental, nothing here to challenge conventional health notions.  But things begin to take a turn to the strange as the article continues:

Adopting a HAES approach may or may not result in a weight change, but that’s not the point. The point is that HAES improves health outcomes long-term and dieting doesn’t. That makes HAES the ethical, effective choice.

The evidence for favouring HAES over weight-loss interventions is strong. First, as has been documented in detail in several books, including The Diet Myth by Paul Campos and The Obesity Epidemic by Michael Gard and Jan Wright, the common obesity scaremongering in the media greatly exaggerates the risks.

It is hard to find a review of The Diet Myth, written by a law professor, by a suitably qualified health professional but The Obesity Epidemic has been criticised by Morgan Downey of the American Obesity Association:

It isn’t hard to find researchers who offer global prescriptions to control body weight; it isn’t hard to find press accounts which hype this or that discovery or new information and it isn’t hard to find dubious or misguided policy prescriptions. But the authors’ real target is science itself. They feel that overweight and obesity just can’t be viewed as a science at all and that biology, physics, have not been helpful and will not be helpful in the future. A big part of their gripe is the energy in/energy out formula just doesn’t seem to work consistently in obesity studies.

In fact, a number of the authors’ insights and observations should cause some serious thinking. But it is curious to note that, although the authors are university professors and although they must cite close to a thousand studies, there is not, as I can read it, one reference to the discovery of leptin, much less the influences of the host of neuropeptides, hormones and other neuroendocrine effects of adipose tissue. One must ask, “In all this research, did they never come across the information about grehlin, PYY 3-36, and other such influencers? If they did come across them, why not reference all that is going on? Where is any analysis, or even mention, of the effects of bariatric surgery on the understanding of the disease process we call obesity?

It seems, judging by the amazon blurbs and reviews, these books offer a sociological analysis of obesity that either ignores science or regards it as irrelevant.  I haven’t read these books and don’t intend to critique them here, however, when an argument is presented to public opinion, without academic references and apparently anti-science, by non-experts it should be regarded as weak evidence in any argument. Unfortunately Ms Aphramor seems to regard it as being fairly robust.  The next part of her article does confirm that she might not be approaching the evidence base impartially:

whatever the risks of a particular weight, the scientific evidence is clear: for the vast majority of people, there is no known safe way to obtain significant weight changes and maintain them in the long-term. Dieting puts bodies in emergency starvation mode and, just as it is difficult to hold your breath for a long time, it is difficult to willingly undereat; your body will make you eat, just as it will make you breathe, in order to survive. The evidence shows that weight lost from dieting is almost always regained within a few years, often accompanied by a few more pounds. Weight loss pills (at least, those that haven’t been found unsafe yet) result in a few pounds lost, but only while you continue them. Even those who undergo the risks of weight-loss surgery find that much of the weight lost is regained in the long term. On the other hand, many naturally thin people cannot manage to gain weight for sustained periods either, no matter how much they try to eat.

This is a rather controversial statement and provoked this response from hospitaldietician in the comments to the Guardian article:

Firstly, all weight loss results in loss of both body fat and lean body mass, predominantly muscle, as the remodelled habitus requires less muscle mass, and energy expended, to move. As muscle tissue has a high metabolic demand, preservation also helps offset some of the reduction in energy expenditure associated wth its loss. Research shows that including exercise from 6-8 weeks into a diet (lets not embrace everything at once, if we want sustained acceptance) helps preserve muscle bulk and expend more energy for its duration – a double whammy of benefit for long term weight control.

We Dietitians must take care not to misrepresent the real issues related to obesity – namely its social, economic, psychological and physiological aspects. Yes, Aphramor is correct to say perhaps we are too obsessed with the ideal BMI and that lifestyle, or indeed waist size, may give us more sophisticated assessment of the impact of extra avoirdupois – in approximately 10-20 years or so when our current diet + lifestyle declares itself.

But current knowledge demonstrates that the percentage of the population with diabetes, hypercholesterolaemia, and hypertension increase with incremental increases in BMI.

[...]

Yes, there is great controversy as to whether a BMI of 27 should be an acceptable cut-off point for health risk rather than the current value of 25. However, to imply that it is possible to have good health pushing a BMI of , say, 40, to appease those who throw in a bit of walking and broccoli with their 3000kcal diet is clinically irrational – and not one that should be entertained by dietitians whose clients are in denial about their weight and health risk. Obesity ostracises its carriers, serving as a visual indicator to others of an individuals dietary habits, and perpetuates low self-esteem.

What is important, especially for the morbidly obese, is to root out the cause of ‘whats eating them’. Inability to address the psychological reasons for such extreme body habitus will of course lead to Aphamor’s self-fulfilling prophecy of the ultimate failure of any weight reducing diet.

Finally, longstanding weight loss requires constant vigilance, but the powerful improvement in self-esteem is sufficient for many to maintain their new shape – despite Aphamor’s assertions. The National Weight Control Registry (http://www.nwcr.ws/Research/default.htm) describes a common theme for those with successful long term weight loss that can be summarised thus: a modest calorie diet (usually around 1400kcal a day) and regular, modest exercise (up to an hour a day of walking etc).

For some obese individuals, focussing on a ‘healthy lifestyle’ may be the single step that starts the journey towards a healthier weight and lifestyle. To suggest that this single step is enough for a morbidly obese individual to achieve health is wrong – clinically and morally.
Empathy should not deter us from presenting the clinical evidence of health risks to our clients.

This comment is consistent with the advice and references provided by the British Dietetic Association (BDA) on weight loss.  While it is interesting that a BDA regulated dietician, Ms Aphramor, can feel compelled to offer advice that apparently goes against the scientific consensus and who may be in breach of the HPC proficiency standards* and standards of conduct** for dieticians that is not my biggest concern.  Ms Aphramor has set up a NHS social enterprise, in conjunction with HAES UK, to promote her ideas.  NHS social enterprises are defined as “organisations that are run along business lines, but where any profits are reinvested into the community or into service developments.  Encouraging social enterprise in health and social care is a key part of the patient led reforms.”.

It appears that these reforms have led to a dietician prepared to step outside of her evidence base to create an enterprise offering easy but wrong solutions to vulnerable people.  Presumably the government did not intend ‘patient led reforms’ to lead to easy but inaccurate answers to hard questions and allow populist anti-evidence enterprises but in this case that seems to have happened.

In my next post on this issue I will take a more in depth look at the HAES movement and how they present their ideas to the public.

Thanks to hospitaldietician for their comments.

*

2.2b

- be able to choose the most appropriate strategy to influence nutritional behaviour and choice
- be able to undertake and explain dietetic treatment having regard to current knowledge and evidence based practice

**You must act in the best interests of service users

You are personally responsible for making sure that you promote and protect the best interests of your service users. You must respect and take account of these factors when providing care or
a service‘ and must not abuse the relationship you have with a service user. You must not allow your views about a service users sex‘ age‘ colour‘ race‘ disability‘ sexuality‘ social or economic status‘ lifestyle‘ culture‘ religion or beliefs to affect the way you treat them or the professional advice you give. You must treat service users with respect and dignity. If you are providing care‘ you must work in partnership with your service users and involve them in their care as appropriate.
You must not do anything‘ or allow someone else to do anything‘ that you have good reason to believe will put the health or safety of a service user in danger. This includes both your own actions and those of other people. You should take appropriate action to protect the rights of children and vulnerable adults if you believe they are at risk‘ including following national and local policies.
You are responsible for your professional conduct‘ any care or advice you provide‘ and any failure to act. You are responsible for the appropriateness of your decision to delegate a task. You must be able to justify your decisions if asked to.
You must protect service users if you believe that any situation puts them in danger. This includes the conduct‘ performance or health of a colleague. The safety of service users must come before any personal or professional loyalties at all times. As soon as you become aware of a situation that puts a service user in danger‘ you should discuss the matter with a senior colleague or another appropriate person.

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Matthias Rath plans to illegally spam every politician in the the EU with the help of his supporters

I received an astonishing email this morning from the European Referendum Initiative (ERI), the Matthias Rath funded organisation working with alternative health groups and, in the past, MEPs.  In this email the ERI detail their strategy for emailing every single MP in Europe with an automated campaign of spam in favour of no regulation of vitamin supplements*.

ANH undermine public health care efforts *updated*

I have an unfortunate compulsion to sign up for mailing lists from organisations working under the auspices of quackery.  As a result of this compulsion the other day I received an email from the Aliance for Natural Health (ANH), supporters of Matthias Rath and agitators against the regulation of the alternative sector.  This email, promoting the latest campaigns from the ANH, argues against bureaucrats who believe health products should be regulated and condemns the perceived machinations of big pharma to suppress natural healing.  It also contains a list of 10 behaviours the ANH want their readership to follow:

Derek Draper repeats some canards of the alternative health industry on nutrition

Derek Draper, as well as having an unreliable CV, has appeared on ITV1’s Kyle’s Academy through his DIY-Therapy website – described as “The one-stop-shop for information and tools to improve your emotional wellbeing.”.  Jon from the magnificent and recently redesigned Holfordwatch has alerted me to a document published by DIY-Therapy ‘The Good Mood Diet‘ which contains some dubious claims typical of nutritionists, such as Patrick Holford – another individual with an interesting history of CV revisions.

The document starts off with a rather simplistic telling of the serotonin hypothesis of depression arguing that lowered levels of serotonin cause depression and that high doses alleviate, it is of course more complicated than that, as this recent review argues.  It also contains the claim that aspartame lowers serotonin levels, a claim wide spread amongst the more alternative corners of the internet but one on which the scientific evidence is confusing, contradictory and limited.

More canards creep in as you read further, especially relating to the effect diet has on mood.  Draper claims that eating food rich in tryptophan can increase brain serotonin, this is a claim not borne out by the scientific evidence. Where diet can affect mood is more likely to be due to the fluctuation of insulin levels related to the amount and type of carbohydrate in a meal and not to tryptophan.  Although there is some evidence that supplementing with tryptophan may be beneficial.    Draper also recommends a protein intake of 60-90g/day, up to 50% more than the recommended daily average for a male adult. There is also slight comedy value in misplaced parenthesis suggesting that rye, oats and barley are in fact wheat.  This is part of a section on ‘bad mood foods’, and betrays a worrying belief in the opiod theory of wheat proteins that has informed the opinions of Andrew Wakefield and others on the alternative fringe of autism science.

The source of these canards appears to be a book titled ‘The Mood Cure’ by Julie Ross, I have not read the book but judging by it’s interpretation of the science of depression it would not feel overqualified sitting next to the works of Patrick Holford in the lifestyle section of your local bookshop. Julie, like Patrick, holds a qualification in psychology, although only an MA, which she feels sufficient to pass herself off as an expert in nutrition and diet.

In fact this raises an interesting point about those who operate in the more alternative spectrum of healthcare, there seems to be little awareness of the limits of professional competence.  Merely holding a qualification in a particular discipline is seen sufficient to hold an experty type opinion in tangentially connected or completely unrelated fields.  Not only that but individuals such as Draper, Ross and Holford seem very keen to enhance their actual credentials through ommission and lack of clarity, there is failure of understanding that the strength of a position in science and healthcare is defined, not by the qualifications of those holding it, but by the strength of the supporting evidence.  It is a shame that the media favour individuals such as Draper and Holford whose arguments of ‘trust me, I’m an expert’ come at the expense of evidence based reasoning and whose personal trust is somewhat undermined by an exaggerated CV.

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Some MEPs make misleading statements to support the quack nutrition industry

*update*

Due to discrepancies and ommissions in EU documents I may have got the names of the attending MEPs wrong.  I have also confirmed that one additional MEP, Mairead McGuinness was also present. I cannot confirm for certain whether Proinsia de Rossa and Gay Mitchell were present, nevertheless I have chosen to keep their names here as they are members of the petition committee (assuming EU documents are up to date).

Before Christmas I investigated how the Matthias Rath funded European Referendum Initiative had enlisted the support of several organisations and individuals including the Irish Associate of Health Stores (IAHS) and the MEP Kathy Sinnott.  Ms Sinnott has now distanced herself from Rath while the IAHS chose not to, now both have colluded to present a misleading and inaccurate petition to the Eurpean Parliament in an attempt to subvert an evidence based review into nutritional supplements.  They have been aided in this attempt by the Irish MEPS, Marian Harkin, Proinsias de Rossa, Mairead McGuinness, Gay Mitchell, Eoin Ryan and the UK MEP Roger Helmer – according to a press release from the Alliance for Natural Health (ANH), advisors to the IAHS and supporters of Rath themselves.

On Monday, the Irish Association of Health Stores (IAHS) defended its petition in the European Parliament against the European Commission’s planned setting of EU-wide maximum limits for dosages of vitamins and minerals in food supplements. The petition, submitted originally in December 2007 with the support of 60,000 Irish citizens, claims that measures to harmonise maximum levels of vitamin and mineral food supplements under the Food Supplements Directive (2002/46/EC)—soon to be implemented by the European Commission—will unduly impact consumers, health stores and practitioners in Ireland.

Now there is sound scientific evidence that supports arguments for the regulation of vitamin and mineral food supplements, not least because there is no proven benefit for healthy individuals but there is the possibility of harm from the taking of such supplements.  It is this that makes the following statements from MEPs so absurd

BANT response to regulation – not entirely honest

The British Association for Applied Nutrition and Nutritional Therapy (BANT) have issued a press release(PDF) expressing their desire for strict regulation of the nutritionist profession under the auspices of the Nutritional Therapy Council (NTC) and, in 2009, the Complementary and Natural Healthcare Council (CNHC). Unfortunately the press release contains a statement that is an astonishing exercise in mendacity.

The British Association for Applied Nutrition and Nutritional Therapy is the largest Professional body representing NT practitioners. BANT was set up as a Company Limited by Guarantee in February 1997. It is a non-profit organisation funded neither by pharmaceutical, agrochemical or government agencies but by member subscriptions and donations. It promotes high standards of education in Nutritional Therapy and high standards of practice and ethics within the profession and acts as a professional body regulating the activities and practice of its members. It also provides opportunities for Continuing Professional Development.

This reads as if BANT are not influenced by commercial or government concerns, are a wholly independent body with a commitment to education and high standards of ethics as well as encouraging practitioners to maintain their continuing professional development.  Unfortunately the facts disagree with this reading.  Any implication of independence is misleading at best, BANT were happy to change their code of ethics after pressure from business interests to allow its members to profit from commission on supplement sales.  An astonishing act that officially sanctioned the ability of practitioners to profit by pushing particular brands of pills on their clients.  Their claims about promoting high standards of education are also suspect.  The British College of Natural Health (BCNH), a BANT approved source of nutritionist qualifications, responded to criticism from Ben Goldacre about the lack of critical appraisal within the industry by stating “everyone [...] is in agreement that critical appraisal from outside (and inside) can be only beneficial, as it is the start point for improvement”.  Fine words you might think, but the BCNH acted on these words by employing a nutritionist firmly embedded in the profit focused side of the industry and who charges hundreds of pounds for tests of no benefit as a scientific advisor.  BANT’s commitment to ethics is also not quite as bold as suggested.  Not only are their ethics swayed by commercial considerations but the head of BANT’s own Ethics Committee breached her own code of conduct and committed a criminal offence by falsely claiming to be on the Nursing Register.  The final point about Continuing Professional Development (CPD) is also misleading, what BANT do not say is that most of their CPD courses are run by supplement companies such as Biocare – “the first choice [...] amongst Nutritionists“.

BANT, despite any claim to the contrary, are a Professional body in thrall to commercial interests, their courses are paid for by industry, their colleges seek scientific advice from industry, their code of ethics is shaped by industry and their lax attitude to ethics is exemplified by the head of their Ethics Committee breaching their rules.   I hope both the NTC and the CNHC see BANT for what they really are, an industrial lobby group with little regard to ethics.

More information on BANT can be found on the excellent Holfordwatch site.

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Matthias Rath, the alternative health eurosceptics and the MEP

Matthias Rath, the deeply odious and murderous quack nutritionist, is collaborating with representatives of the alternative health industry to campaign for a referendum on the Lisbon Treaty and other EU legal decisions.  This alliance incorporates minor political parties in Germany and the Netherlands – AGFG and Partij voor Mens en Spirit respectively, the Alliance for Natural Health (ANH), the National Health Federation (NHF), La Leva di Archimede and the Zeus Information Service, all organised and brought together by the Dr. Rath Health Foundation.   I do not have the Dutch or German necessary to comment on the claims of the political parties but the other organisations are fundamentally dishonest, fraudulent and dangerous.

The Alliance for Natural Health

The ANH are supporters of Matthias Rath and chose to defend his failed attempt to silence Ben Goldacre in Britain’s libel courts despite the fact that Rath was unable to demonstrate that his case had any merit.  Matthias Rath is not the only discredited individual with dangerous ideas and practices that the ANH choose to support, they have been vocal in their support for Andrew Wakefield, the utterly discredited MMR/Autism hypothesis and the libellous and deranged writings of the deeply unpleasant Martin Walker.  In fact the ANH is a repository of many documents attacking the character and motivations of those who ask probing questions of the alternative health industry, including the highly respected Ben Goldacre, Simon Singh, Edzard Ernst and many others.  The ANH also represent the supplements industry and are implacably opposed to the European Food Supplements Directive, an attempt to “harmonise the legislation and to ensure that these products are safe and appropriately labelled so that consumers can make informed choices”.

The National Health Foundation

The NHF are an American organisation that claim to be a consumer education and health freedom organisation with the aim of removing government restrictions on food, supplements and alternative therapies.  However this organisation is committed to more than the unfettered influence of market forces and an uncontrolled alternative health care sector, it actively promotes misleading and plain wrong ideas that potentially have dangerous and lethal consequences.

The NHF are opposed to vaccination and fluoridation amongst other health concepts and promote conspiracy theories, cancer cure quackery, homeopathic autism cures, AIDS denialism and many other egregious and dangerous lies through their suggested reading lists.

La Leva di Archimede

The English section of the La Leva di Archimede website is a collection of conspiracy theories and lies about science from various alternative health sources the world over with the familiar implacable opposition to evidence based healthcare that the previous sites show.

Zeus Information Service

Zeus is mainly a collection of links and articles that present the familiar distortions of science, character assassinations and support for discredited quacks, like Rath and Wakefield.  Zeus also send out a weekly email alerting the alternative health industry and supporters to criticism or support in the press or in blogs (I have had the occasional honour of a mention for this blog).

Dr Rath Health Foundation

The Dr Rath Health Foundation are a despicable and utterly irrational organisation that responded to Matthias Rath’s dropping of his libel case against The Guardian and Ben Goldacre with an unrepentent restating of his view that AIDS does not need to be treated with ARVs and accusations that drugs companies are complicit in genocide.  They believe that there is a conspiracy between oil and drug companies to control the IMF and restrict the actions of Barack Obama and previously claimed that George Bush and Dick Cheney would start WWIII by the 4th November to maintain the hegemony of the oil and drug cartel.  So far so delusionary but these delusions are not restricted to fantasies of armageddon and one world governments that would put an evangelical Christian to shame, they include the belief that vitamins and other quackery can cure AIDS.  A belief that some estimates suggest is responsible for over 300,000 deaths in South Africa alone.  A belief that Matthias Rath is evangelical about spreading to other parts of the world, his current focus seems to be Russia.

eu-referendum.org

These organisations have united under the banner of the European Referendum Initiative, an organisation that ostensibly campaigns against the Lisbon Treaty but a deeper analysis of their website reveals them to be little more than a lobbying group for the alternative health care industry, albeit one that misleads and lies and equates the horrors of the Holocaust with modern science and medicine.  Their aim is to prevent regulation of alternative medicine and campaigning against the Lisbon Treaty is just part of that aim.

The EU Parliament and the MEP, Kathy Sinnott

It would be hoped that this organisation consisting of deceitful lobby groups, anti-science fantasists and murderous AIDS denialists would be shunned the European Parliament and the elected representatives therein. Sadly this is not the case, Kathy Sinnott, MEP for Ireland South and member of the UKIP associated Independence/Democracy Group, has backed the European Referendum Initiative and leant her good name to this Matthias Rath backed organisation.  The support of an MEP is just what with this organisation wants, with it comes access to the halls of power, a name to drop to increase support and the cloak of political respectability.

I have been in contact with Ms Sinnott and put a number of questions to her concerning her involvement with Matthias Rath and the above organisation.  Ms Sinnott states that she had never heard of Matthias Rath, did not know of the link between the European Referendum Initiative and does not back him.  The European Referendum Initiative website clearly states that it is run by the Dr. Rath Foundation both on their homepage and about section and Ms Sinnott has refused to make a comment on or withdraw her support from the European Referendum Initiative.

Regardless of this Ms Sinnott did inform me that her involvement came about through the Irish Association of Health Stores (IAHS) who put her in touch with their scientific advisors(!), the ANH.  It seems the IAHS, like the other lobby groups and industry representatives above, are opposed to the regulation of supplements and alternative therapies.

It is clear from reading some of the questions asked in parliament by Ms Sinnott that she is supportive of many of the views of the Dr Rath Foundation, the IAHS & ANH and their allies.  She is persistently asking questions on the safety of fluoridation,  the non-existent link between mercury and autism, scaremongering over dental amalgam, wifi in schools, and this is just in the last year.  She also has a track record of trying to allow the alternative health industry to profit from health tourism as well as asking for reduced/no VAT on alternative therapies.  It is also interesting to note she has condemned drug companies for carrying out unethical trials in developing nations, a lethal practice of Matthias Rath’s she has not commented on.

Ms Sinnott is naive, scientifically illiterate and an elected official who puts her support for favoured industries before evidence and the rights and health of consumers by arguing for increased market share, reduced taxes and little regulation of the alternative health sector.

A lobby of lies

It is saddening to see lobbying groups, political parties and MEPs actively promote utterly discredited, but culturally persistent, half-truths and lies about medicine, healthcare and herbal supplements.  There seems to be a fundamental disrespect for the role of the scientific method in healthcare or perhaps a gross ignorance of science within much of political and lawmaking institutions.  It is not surprising that elected officials operating within this environment are prepared to consort with highly dubious groups and individuals who flatter their prejudices and confirm their mistaken and ignorant beliefs.  Kathy Sinnott’s inability to appreciate scientific evidence has led her to put her good name to the odious Dr. Rath Foundation and allowed the offensive grouping behind the European Referendum Initiative access to the halls of power.

The alternative health sector has proven time and time again to be incapable of self-regulation, this is why it is of considerable concern that they are lobbying the EU parliament against legislative regulation of their products.  If they succeed will will reach a situation where the deaths and injury from alternative healing fantasies will not just be the responsibility of the practitioner concerned, they will be the responsibility of all those who lobbied against regulation, including elected officials like Kathy Sinnott.

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Chair of the BANT ethics commitee breaks own code of ethics (and commits a criminal offence)

You may remember the British Association of Nutritional Therapists (BANT) as the nutritional therapists body that claims to regulate nutritionists yet is remarkably secretive about its code of ethics and disciplinary procedures, perhaps because it altered them after pressure from the nutrition industry to allow members to accept commission from companies for pushing company pills on to their patients.

Despite this slippage on the ethical banana skin (Fairtrade no doubt) of financial exploitation BANT still maintains that it exists to:

“[...] assist its members in attaining the highest standards of integrity, knowledge, competence and professional practice, in order to protect the client’s interests, nutritionaltherapy and the Nutritional Therapist.”

Unfortunately for BANT and what little reputation that remains untarnished it appears that the Chair of the Ethics Committee, Val Mowlam – the only member of the committee with any training in conventional medicine, is in breach of the code of ethics and has committed a criminal offence.  On the Ethics Committee site Ms Mowlam is described as BSc (Hons) NT, BA, RGN, RHV.  RGN and RHV stand for Registered General Nurse and Registered Health Visitor respectively and refer to registered members of the Nursing & Midwifery Council (NMC) who hold these qualifications.  Such qualifications give, as is their intent, the impression that the holder is a competent and regulated individual, this presumably has market value when touting for customers.  This might explain why Ms Mowlam is using these titles on websites advertising her services, after all it is reassuring to know that you are going to see a registered and regulated health professional.  Unfortunately Ms Mowlam isn’t.

Ms Mowlam’s qualifications and experience are not in doubt, but she is neither registered with nor regulated by the NMC.  Thus it is a very serious matter for her to use these qualifications professionally while not on the register.  The NMC are very clear about this:

The NMC’s position regarding the use of qualifications after registration has lapsed is governed by article 44 of the Nursing and Midwifery Order 2001:

“44 (1) A person commits an offence if, with intent to deceive (whether expressly or by implication-
(a) he falsely represents himself to be registered in the register,…
(b) he uses a title referred to in article 6(2) to which he is not entitled…
(5) A person guilty of an offence under this article shall be liable on summary conviction to a fine not exceeding level 5 on the standard scale.”
Article 6(2) states:
“6 (2) Each part shall have a designated title indicative of different qualifications and different kinds of education or training and a registrant is entitled to use the title corresponding to the part of the register in which he is registered.”

It is important, therefore, for nurses and midwives to distinguish between their qualifications and registration status. Those who allow their registration to lapse can still refer to the fact that they are a qualified nurse, midwife or specialist community public health nurse but must not give the impression that they have a current registration.
Nurses and midwives must not cite their previous registration with their name, for example, by placing initials relating to this registration after their name on business cards, e.g. Jane Smith RN, RM, when Jane Smith is currently only registered on the midwives’ part of the register or Jane Smith RN, when Jane Smiths’ registration has lapsed. In doing so it could have the effect of misleading members of the public and that anyone doing so may be committing a criminal offence.

This is a position shared by BANT whose own code states that:

8.7
c) The law makes it a criminal offence for anyone who does not hold the relevant qualification to use any of the titles specified hereunder or to use any other title or description which suggests or implies that he is on the appropriate statutory register.
Titles include; Chemist, Chiropodist, Chiropractor, Dental Practitioner, Dental Surgeon, Dentist,
Dietician, Doctor, Druggist, General Practitioner, Medical Laboratory Technician, Midwife, Nurse,
Occupational Therapist, Optician, Orthoptist, Osteopath, Pharmacist, Physiotherapist,
Radiographer, Remedial Gymnast, Surgeon, Veterinary Practitioner, Veterinary Surgeon. (L).

As chair of the BANT ethics committee it is unacceptable for Ms Mowlam to breach the BANT ethics code by committing this criminal offence.  To have such a high profile member with a responsibility for upholding the code of ethics and passing judgement on breaches of this code to break this same code in such a flagrant and criminal manner is highly embarrassing.  Or it would be if BANT were prepared to make their code of ethics public.  As Holfordwatch have testified BANT like to keep their code of ethics, like their ethics committee, secret and away from the prying eyes of the public.  This contrasts with serious regulatory bodies like the NMC that are statutorily obliged to make their codes and their committees decisions public.  The public would have no way of knowing if Ms Mowlam’s breach of criminal law was also a code of ethics violation so would be unable to complain about her to BANT.  If no complaints were recieved then BANT would not be obliged to take any action and Ms Mowlam will be secure in her job. If you want to complain about Ms Mowlam then feel free but you won’t get a code of ethics from BANT nor will any decision be made public.  You get the feeling that this is a situation that BANT would like to maintain. After all they are a lobbying group representing nutritionists and in cahoots with the vitamin pill manufacturers, it would be bad for business to publicly admit mistakes.

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Homeopaths in Ghana

In recent weeks we’ve seen the beginning of the end for AIDS quackery in South Africa with Matthias Rath dropping his libel claims against The Guardian and Ben Goldacre and more recently the replacement of Health Minister Manto Tshabalala-Msimang, known as Dr Beetroot for her belief that healthy eating rather than ARVs is the best treatment for AIDS, with Barbara Hogan in the recent political upheaval.  Unfortunately this does not represent the end of the promotion of quackery within Africa.

Patrick Holford distorts research findings on statins to push his pills

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I am a masochist. This is why I signed up for ex-Visiting Professor Patrick Holford’s health e-news bulletins. Normally these emails consist of a plug for some dubious piece of pseudo-scientific equipment or vitamin supplements from one of the companies Patrick has a financial interest in. However, sometimes you get his thoughts on a new scientific study or perhaps an attack on one of his many critics. These type of things are usually covered by the always admirable Holfordwatch but Patrick does produce a surfeit of nonsense so this time round I think I will deal with it.

The deceptive lies by deliberate misinterpretation of science by the CAM community

Via the ever hilarious Zeus mailout I have come across this article from the What Doctors Don’t Tell You site (WDDTY):

It was news when it was first revealed three years ago – and it was news again last week: antioxidant vitamins can speed up the development of cancer. But the researcher who first published the study has now admitted that she got it wrong.

The original study – which made headlines around the world – found that cancer patients who took either vitamin A (beta-carotene) or E (alpha tocopherol) supplements were 40 per cent more likely to suffer a recurrence of their cancer than those who didn’t take any supplements.

Ever since, nutritionists and alternative therapists have been on the back foot, and have tried to defend the antioxidants. But their task was made even tougher last week when the prestigious Cochrane Collaborative released a meta-analysis that suggested that antioxidants may even shorten our life.

But the researchers, led by Isabelle Bairati from the Quebec Research Centre, who published the 2005 study, have re-analysed their original data, and have discovered they got it wrong. The only people in the study who were seeing their cancer return were smokers who refused to kick the habit while they were receiving radiation therapy or chemotherapy.

Now leaving aside the odd inaccuracy such as that beta-carotene is a Vitamin A precursor and not Vitamin A by reading this article you would get the impression that supplementing with vitamin A and E has no effect on cancer recurrence but smoking does and that the researchers were forced into a humiliating retraction. This is merely CAM lies.

BANT consider profit more important than ethics

According to their website the British Association for Applied Nutrition and Nutritional Therapy (BANT) is a conscientious professional organisation for nutritionists. It’s primary function is described as being

to assist its members in attaining the highest standards of integrity, knowledge, competence and professional practice, in order to protect the client’s interests, nutritional therapy and the Nutritional Therapist.

BANT makes clear that:

[it] was set up as a Company Limited by Guarantee in February 1997. It is a non-profit organisation funded neither by pharmaceutical, agrochemical or government agencies but by member subscriptions and donations.

and that:

BANT promotes high standards of education in Nutritional Therapy and high standards of practice and ethics within the profession.

BANT acts as a professional body regulating the activities, training and Continuing Professional Development of its practitioners.

So far so good, any professional body that sees itself as a regulator must remain untainted by whims of the market and must uphold the highest standards of public behaviour. However, as Holfordwatch discovered last year, BANT see themselves as

a professional association and not a regulator

so it is quite mystifying why their public webspace would use the word ‘regulation’ when what they really mean is that they don’t regulate. Regardless of this bit of Orwellian doublespeak one would expect a professional association, as BANT claim they do, to promote high standards of ethics and practice.

The pill pushing proselytising of Patrick Holford

Patrick Holford is a fellow of BANT. BANT have a code of ethics (thanks to Holfordwatch for the link). The BANT code of ethics clearly allows its members to earn commission and profit from selling products to clients which, as Holfordwatch point out, is inappropriate behaviour from want-to-be healthcare professionals. However, despite its faults, the BANT code does apply to its members and they are expected to adhere to its strictures.

Patrick Holford makes a career out of selling products and books and his grasp of science is shaky at best. I recently discovered a webchat from early last year that superbly illustrates the idiocies and unethicaliness of Patrick, who might be expected to adhere to the BANT code of ethics, as well as highlighting the relentless profit driven proselytising of his own products. In fact I have my suspicions that the bulk of the Holford Head is a clockwork counting machine that, with a ping and the roll of a pound sign across Patrick’s pupils, rapidly calculates the commercial benefit of any given situation. So I have decided to analyse this webchat with respect to Patrick’s ignorance, bad advice, wrong advice, profit making and breaches of the following sections of the BANT code of ethics:

6.3 The Member should strive for a good relationship and full co-operation with medical and other recognised health professions. Clients must not be led to believe that Nutritional Therapy replaces medical care.

7.1 b). The Member must never promise cure or recovery. Nutritional Therapy claims that the advice given may enhance the body’s natural means of resistance to disease.

7.1 e). The Member must not advise a client in any case which exceeds his capacity or competence, but should call in another nutritional therapist or refer the client to the appropriate practitioner or Registered Medical Practitioner.

12.1 The Member, placing an advertisement, must satisfy the requirements of the British Code of Advertising Practice and the Advertising Standards Authority (www.asa.org.uk).

Anyway, let us begin………….